Margaret Lafferty Nicole Morath Chandler Matcovich Gabriella Ferro Stephanie Holtje Amanda Pedi Professor Brennan Monmouth University Individualized Education Plan 08 June 2017NOTICE OF PROPOSED INITIAL EVALUATION Student's Name: Gabriella Smith Grade: 3" Address: 42 Hawk Avenue Old Bridge Township, NJ ‘Student’s School: Memorial Elementary School Date: November 24, 2016 Dear Nicole Smith, ‘The purpose of this letter is to notify you that the Old Bridge Township schoo! district proposes to evaluate your child for eligibility for special education and related services. This determination was made as the result of your participation in an evaluation planning meeting held on November 19°, ‘The planning team considered the following factors in making this determination I. Academic considerations Mathematics 2. Behavioral considerations: None 3. Social considerations: None. The district proposes to assess your child as follows: 4, Areas of AT Risk performance: Mathematics 5. Assessment Procedures: Evaluation will be completed 6, Evaluators (by discipline): Stephanie Holije, Amanda Pedi, and Maggie Lafferty 7. The following is a description of any other options, other than evaluation, discussed (when other options were considered) and the reasons why they were rejected: 8, The evaluation process to determine your child’s eligibility for special education and related services is, scheduled to begin on (date December 14), However, your consent is required in order for the district to proceed. Please read and sign the consent form at the bottom of this notice. ‘The evaluation may begin Upon receipt of your consent.PROCEDURAL SAFEGUARDS STATEMENT: As the parent of a student, or as an adutt student, who may have disabilities, you have rights regarding the identification, evaluation, classification, the development of an IEP, placement, and the provision of a free, appropriate public education under the New Jersey Administrative Code for Special Education, N.J.A.C. GA:14, A description of these rights, which are called procedural safeguards, is contained in the document, Parental Rights in Special Education (PRISE). This document is published by the New Jersey Department of Education. ‘A copy of PRISE is provided to you upon referral for an initial evaluation, upon each notification of an IEP meeting, upon reevaluation, and when a due process hearing is requested. In addition, you may request a copy by contacting Maggie Lafferty at 973-751-8329 ext, 1004 For help in understanding your rights, you may contact any of the Following Maggie Lafferty 973-751-8329 ext. 1004 © Statewide Parent Advocacy Network (SPAN) at 1(800) 654-7726 ‘© New Jersey Protection and Advocacy, Ine. at 1(800) 922-7233 © ‘The New Jersey Department of Education through the Old Bridge Township County Office, Karen Furman. 673-762-9473 Please Note: ‘A school district may not use a parent's refusal to consent to one activity under this proposal to deny a child any other service or benefit, This means you may consent to allow the district to initiate those portions of the proposal with which you agree while you use the appropriate form of dispute resolution to resolve those portions of the proposal with which you disagree [See 34 CFR. 300.505(e)]. The district ‘must proceed with the activities for which you have given consent. If you have any questions regarding this notice, please contact me. Sincerely, Maggie Lafferty Child Study Team- Case Manager 973-751-8329 ext. 1004 PARENTAL CONSENT FORM have read the Ch, BCAGOC TO LLiSKUP (name of distriet)’s proposal to evaluate my child and Cis jye/do not give). Suciap my consent to conduct the evaluation. I understand that my SGosent is voluntary and may be revoked at any time. 1 also understand that iT do not consent tothe evaluation, the O/C Bridge Seder (sti(#ame of district) may initiate mediation or a due process hearing wo obinn const.) f/ Lrg 4 WAS U2 ‘ParenvGuardian) (Date)